Investigating Indian oil sardine aggregation events in coastal waters of the southeastern Arabian sea.

The southwest coast of India experiences frequent Indian oil sardine (IOS) nearshore aggregation events, especially in the coastal waters off Kerala. These ephemeral dense IOS aggregation events are known as "Sardine Run". To investigate the reason and provide a scientific basis for these sporadic events, satellite/model-derived physical, meteorological, and biological parameters were analysed. Sea Surface Temperature during a majority of events was in the range of 26-29 °C, agreeing with the reported temperature conditions for IOS in the Arabian Sea. Additionally, a marginal lowering of SST as an effect of precipitation before most of the events might have attracted IOS towards the near-coastal waters in addition to the phytoplankton diet availability, resulting in the aggregation event. However, different scenarios also depicted coastal warming and probable hypoxic conditions in degrading IOS habitat and resulting in beach aggregation events. During most of the IOS aggregation events, the wind and surface current direction was alongshore/coastward, which complemented the propagation of live IOS shoals towards the beach.

Analyzing working time and efficient caries removal using a novel bioactive caries detecting dye and air polisher prophy for caries excavation: randomised clinical trial.

OBJECTIVES: This study aims to analyze the working time consumed during caries excavation and pain perception while using a novel Bioactive caries-detecting dye solution (BCD), an Air Polisher Prophy and a combination. MATERIALS AND METHODS: Four groups (in each group, n = 20 permanent teeth) were selected from 60 people between 17 and 40 years of age. The study included teeth with occlusal dentinal caries in the molars with cavity entrance sizes of less than 2 mm (clinically and radiographically). Randomization software was used to assign patients to various groups. Group A: Conventional Rotary Drilling, Group B: BCD + Mechanical Excavation (Spoon Excavator), Group C: Air Polisher Prophy, and Group D: BCD + Air Polisher Prophy 0.5 mL BCD was applied with a micro brush to the carious tooth surface for 40 s in groups B and D. After that, radiographs were performed to see if the radiopaque extension was visible. For mechanical caries extraction, a spoon excavator was used for group B, and an air polisher prophy was employed for group D. For mechanical caries extraction, a spoon excavator was utilized for group B. An air polisher prophy was employed for group D. Multiple applications of the BCD were used in the event of residual caries. Working time and pain experienced during caries excavation were registered using the Verbal Pain Scale (VPS) (score 0-4), and caries removal was clinically graded using the modified Scale (score 0-5). RESULTS: The time taken was Group A, Group D, Group B, and Group C, according to statistical analysis using ANOVA and the Post Hoc Test (275.02, 403.8, 461.98, 615.41 s, respectively). Group A had the highest mean VPS (1.85), whereas Group B had the most minor pain (0.6), followed by Group D (1.2) and Group C (0.6). (1.45). Group C (2.35), followed by groups D (1.75), B (1.30), and A (1.30), had ineffective caries eradication (0.90). (p < 0.05). CONCLUSIONS: compared to group C, groups B and D took less time and had less/no pain while excavating caries. Compared to traditional mechanized caries removal methods, the chemo-chemical BCD can diagnose and aid in successful caries removal with minimal pain. CLINICAL RELEVANCE: The outcomes of the present study demonstrated that the chemo-chemical bioactive caries detecting dye solution has the potential to identify and help in effective caries removal before mechanized caries removal methods.

Effects of eye dominance on shade matching and color perception among the dentist population.

Objectives: The purpose of this study was to evaluate the influence of eye dominance on color perception, and shade matching. Materials and Methods: A total of 104 participants were selected for the study. There were 3 groups: Group I: 3rd and 4th year dental students and interns (n = 40); Group II: postgraduates (n = 34); Group III: senior residents and faculty members (≥ 6 years of clinical experience) (n = 30). All participants were evaluated for congenital color blindness with Ishihara plates, their dominant eye with Mile's test, and their color perception with the Farnsworth-Munsell 100 hue test. The shade guide test was used for shade matching with a second corresponding set of Vitapan classical shade guides. Results: The results of Mile's test revealed that 60.6% were right-eye dominant and 39.4% were left-eye dominant. There was a statistically significant difference among all participants between the dominant eye and the non-dominant eye in shade matching. Conclusions: The dominant eye has a positive effect on shade matching and the ability to match shades becomes better with an increase in clinical experience.

Local Anesthesia Onset and Pain Perception in Hemophilic and Thalassemic Conditions.

The study aims to evaluate and compare the onset of local anesthesia (LA) and pain perception during endodontic treatment in hemophilic and thalassemic patients. Methods: The study included 90 patients with symptomatic irreversible pulpitis of the mandibular molars. Three groups (n = 30 in each group) were included. Group 1: hemophilic patients; group 2: thalassemic patients; and group 3: individuals without any systemic diseases. Onset of LA and visual analogue scale (VAS) scores was recorded immediately after the administration of local anesthesia, during the pulp exposure procedure, and during canal instrumentation, and were compared between the three groups. Frequency distribution, ANOVA, and linear regression analysis (p < 0.05) were applied. Results: The mean onset time was 46 ± 34 s in the hemophilic group, 42 ± 23 s in the thalassemic group, and 38 ± 12 s in controls, but the differences were statistically insignificant. After LA administration (LA-VAS), all three groups experienced a statistically significant reduction in pain (p = 0.048). On pulp exposure (PE-VAS) (p = 0.82) and during canal instrumentation (CI-VAS) (p = 0.55), there was no statistically significant difference in pain perception between the groups. The coefficients indicate a positive correlation between the VAS and onset time, indicating a positive reduction in the VAS following the administration of LA. Conclusions: Hemophilic patients exhibited a clinically longer average onset time for LA. However, the difference among the three groups with regard to the overall pain perception after LA administration, during and after pulp exposure, and during canal instrumentation was statistically insignificant.

Diagnosis and Assessment of Dental Caries Using Novel Bioactive Caries Detecting Dye Solution.

BACKGROUND: The goal of materials should be early caries detection, removal of carious lesions, and reduction of dentin hypersensitivity. Thus, the study aims to determine the efficacy of a bioactive caries detecting dye (BCD) for the diagnosing and mechanical removal of occlusal and proximal dental caries. METHODS: Patients with occlusal (A1, A2) and proximal carious lesions (B1, B2) were treated with the rotary technique and BCD solution on 120 teeth (n = 60 for each). Group 1: Excavation was performed using diamond points. Group 2: 0.5 mL of BCD solution was scrubbed for 20 sec and excavation was performed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required, VAS for pain, VAS for facial expression, and sound eye motor scoring were scored during excavation. Post-restoration evaluation was performed at 3, 6, and 12 months (FDI criteria). RESULTS: The chi-square test revealed that the A1 (197.90 30.97 s) and B1 (273.06 69.95 s) had significantly less mean procedural time than the A2 (292.13 44.87 s) and B2 (411.86 88.34 s). BCD (A2, B2) group showed good patient acceptance, less pain during caries excavation VAS (p = 0.001, FACE (p = 0.001), and SEM (p < 0.001) analysis than the rotary group. There was a statistically insignificant difference between groups immediately (p = 0.235), (p = 0.475) and after 24 h (p = 0.561), (p = 0.688). Color score, hardness of excavated surface, and caries removal score for occlusal and proximal groups showed insignificant differences between the groups. BCD group showed significantly less mean caries excavated volume for the occlusal group (p = 0.003) as compared to the proximal group (p = 0.417) evaluated by 3D scanner. Evaluation of restoration after 3-, 6-, and 12 months intervals (Occlusal caries group (p = 0.247), (p = 0.330), and (0.489) and Proximal caries group (p = 0.299), (p = 0.594), and (0.494)) was acceptable for both the groups. CONCLUSION: BCD helps in identification of dental caries clinically, radiographically, and in effective removal of denatured teeth with less pain or sensitivity.

Analysis of Pulp Tissue Viability and Cytotoxicity of Pulp Capping Agents.

The present research study assessed the cell viability and cytotoxic effect of mineral tri-oxide aggregate (MTA), Tetric N-Bond Universal bonding agent, Theracal PT (pulpotomy treatment), and platelet-rich fibrin (PRF) as pulp capping agents on human dental pulp stem cells (hDPSCs). The cells were isolated from the pulp tissue of an extracted healthy permanent third molar. After four passages in Dulbecco's Modified Eagle's Medium, the primary cells were employed for the investigation. The test materials and untreated cells (negative control) were subjected to an Methylthiazol-diphenyl-tetrazolium (MTT) cytotoxicity assay and assessed at 24-, 48-, and 72-h intervals. The Wilcoxon matched-paired t-test and Kruskal−Wallis analysis of variance (ANOVA) test were applied (p < 0.05). PRF imparted the highest cell viability at 48 h (p < 0.001), followed by MTA, Theracal PT, and Tetric N-Bond. Similarly, PRF had the highest potential to enhance cell proliferation and differentiation (p < 0.001), followed by Theracal PT, MTA, and the bonding agent at the end of 24 h and 72 h, respectively. Finally, PRF sustained the viability of human primary dental pulp stem cells more effectively than Theracal PT and MTA; however, the application of a Tetric N-Bond as a pulp capping agent was ineffective.

Enhanced visualization of the root canal morphology using a chitosan-based endo-radiopaque solution.

OBJECTIVES: This study aimed to investigate the efficacy of ionic and non-ionic-based contrast media (in vitro study) and the combinatorial effect of chitosan-based endo-radiopaque solution (CERS) (in vivo study) for visualization of the root canal anatomy. MATERIALS AND METHODS: In vitro study (120 teeth): The root canal of maxillary premolars and molars (in vitro group 1 and 2 respectively, n = 60 each) were analyzed using 4 different contrast media (subgroups: Omnipaque 350, Iopamidol, Xenetix 350, and Urografin 76; n = 15 each) in combination with 5.25% sodium hypochlorite (NaOCl). Based on the results of the in vitro study, in vivo study (80 teeth) was done to compare Xenetix 350 + 5.25% NaOCl with CERS (in vivo group 1 and 2 respectively, n = 40 each) on maxillary and mandibular premolars and molars. Two endodontists used radiovisiography to assess the depth of ingress and identify the aberrant root anatomy after access cavity preparation, and after initial cleaning and shaping of canals. Kruskal-Wallis test was used for in vitro comparison (p < 0.05), and Wilcoxon signed-rank test and Mann-Whitney U test for in vivo analysis (p < 0.01). RESULTS: In vitro study, Xenetix 350 + 5.25% NaOCl facilitated a significant higher visualization (p < 0.05). For in vivo study, CERS had a statistically significant depth of ingress (p < 0.01), and was efficient in identifying the aberrant root canal anatomy of premolars and molars. CONCLUSIONS: CERS facilitates better visualization of the root canal anatomy of human premolars and molars.

The Next Billion Users of Visualization.

We argue that visualization research has overwhelmingly focused on users from the economically developed world. However, billions of people around the world are rapidly emerging as new users of information technology. Most of the next billion users of visualization technologies will come from parts of the world that are extremely populous but historically ignored by the visualization research community. Their needs may be different to the types of users that researchers have targeted in the past, but, at the same time, they may have even more to gain in terms of access to data potentially affecting their quality of life. We propose a call to action for the visualization community to identify opportunities and use cases where users can benefit from visualization; develop universal design principles; extend evaluations by including the general population; and engage with a wider global population.

Novel bioactive caries-detecting dye solution: Cytotoxicity, antimicrobial activity, scanning electron microscope, and stereomicroscopic analysis in diagnosis of dental caries.

AIM: The aim was (1) to study the cytotoxicity of novel Bioactive Caries-detecting Dye solution (BCD) and its antimicrobial activity against Streptococcus mutans, Lactobacillus acidophilus, Actinomyces naeslundii, and Candida albicans and (2) comparative assessment of BCD and Carie-Care for efficient removal of caries (stereomicroscope) and dentin tubule occlusion (scanning electron microscope [SEM]). MATERIALS AND METHODS: For BCD cytotoxic study (direct contact method), colorimetric MTT assay, and cell line study(L929 mouse fibroblast NCTC clone 929 strain L) was performed. Xenetix 350, chitosan, nanohydroxyapatite (nHA), BCD, and Carie-Care solutions were subjected to the antimicrobial activity through blood agar well diffusion method, and the minimum inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) were determined. On 20 extracted human carious teeth a comparative pilot study was done for BCD (Group A, n = 10) and Carie-Care (Group B, n = 10), and evaluated visually and radiographically. After mechanical excavation of caries with a spoon excavator, teeth sectioned longitudinally and stereomicroscopically were evaluated (8x-40x) by two observers. The percentage of dentinal tubule occlusion was evaluated with SEM for both solutions. Statistical kappa analysis of agreement was 0.7-0.8 (P < 0.01). Mann-Whitney test ranks and Wilcoxon signed-rank test (P = 0.01) were applied. RESULTS: Cytotoxicity test revealed BCD to be nontoxic and biocompatible. Antimicrobial tests (zone of inhibition) showed BCD > chitosan > chlorhexidine > Carie-Care > Xenetix 350 > nHA. MIC and MBC values suggested chlorhexidine > BCD > Carie-Care. Stereomicroscopic analysis showed effective mechanical removal of caries in BCD without residual dye in the dentinal tubules as compared to Carie-Care. Dentinal tubule occlusion (SEM analysis) was 80%-85% for BCD and 10% for Carie-Care. CONCLUSIONS: Profound synergistic effect for BCD was observed with advantage of radiographic assessment.

In vitro comparative evaluation of antifungal efficacy of three endodontic sealers with and without incorporation of chitosan nanoparticles against Candida albicans.

AIM: The aim of this study was to compare the antifungal efficacy of three endodontic sealers (AH Plus, Apexit Plus, and MTA Fillapex) with and without the incorporation of chitosan nanoparticles against Candida albicans. MATERIALS AND METHODS: The present study was carried out by the Kirby-Bauer method. C. albicans were cultured in Sabouraud Dextrose Agar plates. Filter papers (n = 10) were placed in the cultured Petri dishes and the sealers were mixed according to the manufacturer's instructions and placed on the top of the filter papers. Group division of sealers is as follows: Group I - AH Plus, Group II - Apexit Plus, and Group III - MTA Fillapex. Group IC, Group IIC, and Group IIIC were the addition of 2% chitosan nanoparticles with respective sealers. Plates were incubated for 18 h, and the zone of inhibition was measured with a measuring scale and values (in millimeter) were recorded. Statistical analysis was done by one-way analysis of variance followed by post hoc multiple pair-wise comparisons. RESULTS: All the tested groups showed statistically significant difference (P < 0.05) from each other. Two percent chitosan-incorporated groups showed superior zone of inhibition compared to sealers used alone. Group IC (16.35 ± 0.71 mm) had the highest zone of inhibition followed by Group I (13.8 ± 0.86 mm). For the remaining groups, the zone of inhibition was in the following order: Group IIC > Group II > Group IIIC > Group III. CONCLUSION: AH Plus sealer mixed with 2% chitosan showed significantly higher antifungal property. Mixing of 2% chitosan with endodontic sealer provides an added advantage so that endodontic re-infections can be minimized and will be helpful in retreatment cases.

Assessment of pain and dissolution of apically extruded sealers and their effect on the periradicular tissues.

AIM: This study aimed to evaluate the intensity of pain after unintentional extrusion of resin-based and calcium hydroxide (Ca[OH]2)-based endodontic sealers as well as their influence on the periradicular tissues. MATERIALS AND METHODS: A total of 120 single-rooted teeth exhibiting extrusion of sealer in the postoperative radiographs were included in the study. According to the sealers used, the teeth were divided into four groups (n = 30): Group I - AH Plus®, Group II - Resino Seal, Group III - Sealapex™, and Group IV - Apexit® Plus. Postoperative pain was assessed at 0-6 h, 6-12 h, 12-24 h, and 24-48 h of obturation using Visual Analog Scale. Radiographs were taken at 3, 6, and ≥9 months to 1-year follow-up and compared with baseline radiographs to assess the dissolution of extruded sealers and healing of periradicular tissues. STATISTICAL ANALYSIS: ANOVA, Kruskal-Wallis, and Pearson's Chi-square test were used. Statistical significance level was set at P ≤ 0.05. RESULTS: Postoperative pain intensity was higher in case of AH Plus® sealer followed by Sealapex™ up to 12 h of obturation and was statistically nonsignificant. Apexit® Plus at all time intervals showed statistically significant less pain intensity than AH Plus® and Sealapex™ but not from Resino Seal group. At 9-month follow-up, better healing of periradicular tissues was shown by AH Plus® (48.1%) followed by Apexit® Plus (44.4%) and Sealapex™ (41.2%) with statistically nonsignificant difference. CONCLUSION: In case of periapical extrusion, both resin-based and Ca(OH)2-based sealers caused postoperative pain. Both Ca(OH)2- and resin-based sealers did not influence the treatment outcome.

Comparing the effectiveness of four desensitizing toothpastes on dentinal tubule occlusion: A scanning electron microscope analysis.

INTRODUCTION: Dentin hypersensitivity (DH) is a sudden short sharp pain best explained by hydrodynamic theory. Several agents are available throughout the market that can treat DH either by blocking the nerves that helps in conducting pain or by blocking the open dentinal tubules. The aim of the present study was to compare the tubule occluding efficacy of four different desensitizing dentifrices under scanning electron microscope (SEM). MATERIALS AND METHODS: Sixty-two dentin blocks measuring 5 mm × 5 mm × 3 mm were obtained from extracted human molar teeth and were randomly divided into five groups: Group 1 - no treatment (control, n = 2); Group 2 - Pepsodent Pro-sensitive relief and repair (n = 15); Group 3 - Sensodyne repair and protect (n = 15); Group 4 - Remin Pro (n = 15); Group 5 - Test toothpaste containing 15% nano-hydroxyapatite (n-HA) crystals (n = 15). The specimens were brushed for 2 min/day for 14 days and stored in artificial saliva. After final brushing, specimens were gold sputtered and viewed under SEM at ×2000 magnification. Results obtained were statistically analyzed using nonparametric Kruskal-Wallis test and least significant difference post hoc test. RESULTS: All test groups showed significant increase in dentin tubule occlusion as compared to control group. The highest percentage of tubules occluded was shown by Group 4 and Group 5 which was significantly different from other groups (P ≤ 0.05), and there was no significant difference in tubule occlusion among them. CONCLUSION: Newer desensitizing dentifrices containing 15% n-HA and Remin Pro can provide effective tubule occlusion and thereby reduce the pain and discomfort caused by DH.

Nanotechnology in Dentistry: Clinical Applications, Benefits, and Hazards.

Nanotechnology is emerging as an interdisciplinary field that is undergoing rapid development and has brought about enormous changes in medicine and dentistry. Nanomaterial-based design is able to mimic some of the mechanical and structural properties of native tissue and can promote biointegration. Nanotechnology has various applications in dentistry, including dentition renaturalization, therapy for dentin hypersensitivity, complete orthodontic realignment in a single visit, covalently bonding diamondized enamel, enhancing properties of root canal sealers, and continuous oral health maintenance using mechanical dentifrobots. A range of synthetic nanoparticles such as hydroxyapatite, bioglass, titanium, zirconia, and silver nanoparticles are proposed for dental restoration. This review focuses on the developments in the field of nanomaterials in dentistry in the form of tissue regeneration materials, implantable devices, nanocomposites, endodontic sealers etc. and issues of patient safety.

Comparison of efficacy of three different desensitizing agents for in-office relief of dentin hypersensitivity: A 4 weeks clinical study.

AIM: To evaluate the effectiveness of three different pastes containing 5% NovaMin, 8% arginine, and 15% hydroxyapatite nanoparticles (n-HA) respectively in the treatment of dentin hypersensitivity (DH). MATERIALS AND METHODS: A 4 weeks study was conducted on 45 adult patients with cervical abrasions leading to hypersensitivity of two or more teeth anterior to molars. Patients were divided into three toothpaste groups. Group I: 5% NovaMin, Group II: 8% arginine, Group III: 15% n-HA. Sensitivity was assessed at baseline, immediately after application and after 1-week and 4 weeks. Tactile stimuli response using a visual analog scale and standard cold air blast using Schiff cold air sensitivity scale were used to compare the efficacies of toothpastes after a single application. STATISTICAL ANALYSIS: Two-way analysis of variance and post-hoc Tukey test were used and P ≤ 0.05 was considered statistically significant. RESULTS: Visual analog scale analysis: Group III and Group II showed statistically significant reduction in DH at all-time intervals when compared with Group I. In SCA analysis there is no statistically significant difference between Group II and Group III immediately after application. CONCLUSION: Toothpaste containing 15% n-HA was found to be most effective in reduction of DH after a single application up to a period of 4 weeks followed by 8% arginine and 5% NovaMin toothpastes.

Root canal irrigants: a review of their interactions, benefits, and limitations.

Endodontic treatment success depends on a combination of appropriate instrumentation, effective irrigation and decontamination of root canal spaces to apices, and obturation of the root canals. Irrigation of the root canal is paramount in determining periapical tissue healing. This article reviews presently available root canal irrigants, their interactions, advantages, and limitations. For this review, the authors performed a Medline search for all English language articles published through January 2014 with "root canal irrigants" and "endodontic irrigants" as keywords.

Prevalence of Rubber Dam Usage during Endodontic Procedure: A Questionnaire Survey.

AIM: To determine the prevalence and frequency of rubber dam usage for endodontic procedures among general practitioners, specialized practitioners, undergraduate final year students and Endodontists in the state of Odisha, India. METHODOLOGY: A pre-piloted questionnaire was distributed among 737 subjects. Dentists and final year students were surveyed in relation to their prevalence of rubber dam usage. STATISTICAL ANALYSIS USED: Chi-square/ Fisher Exact tests have been used to find the significance of study parameters on categorical scale between two or more groups. RESULTS: Overall response rate was 71%. While about 94% of the subjects knew the use of rubber dam, 30% have used it for root canal cases and 23% use them for all cases of root canal treatment. Use of rubber dam was 15.4% in paediatric patients and 34.4% in adult patients. 68% of subjects received knowledge about rubber dam usage in undergraduate school. 75% felt that rubber dam should be compulsory before endodontic treatment & 90% were willing to gain knowledge through training and continuing dental education programs. CONCLUSION: Whilst rubber dam is used frequently for root canal treatment than operative treatment, in the present survey there is a low prevalence of its usage during endodontic therapy. This presents quality issues, as well as medico-legal and safety concerns for the professional and patients alike. Greater emphasis should be placed on the advantages of using rubber dam in clinical dentistry at dental school and through continuing dental education for practitioners to update their knowledge.

Prevalence and Incidence of Gemination and Fusion in Maxillary Lateral Incisors in Odisha population and Related Case Report.

AIM: A survey was conducted to analyze the prevalence and incidence of dental anomalies in relation to maxillary lateral incisors in the Odisha population. A multidisciplinary approach for aesthetic management of a geminated tooth is described. MATERIAL AND METHODS: A total of 1062 subject, aged between 15-30 years (724 males and 338 Females) were randomly screened at Institute of Dental Sciences, Bhubaneswar, Odisha India. Each subject was examined clinically and radiovisuographically for dental anomalies in relation to maxillary lateral incisors. In the related case described, endodontic management and aesthetic correction of geminated maxillary lateral incisors was done. RESULTS: Five dental anomalies i.e. gemination, fusion, missing lateral incisors (both unilateral and bilateral), peg shaped incisors (unilateral and bilateral), and dens in dente were observed. Anomalies found were Peg shaped; 2.82%, Missing;1.88%, Gemination;0.28%, Fusion;0.18% and Dens in Dente;0.18%. CONCLUSION: Comparison of these results with that of other studies indicated that anomalies in lateral incisors occur at different frequencies among various countries and communities in the world. In the case since maxillary lateral incisors are in the aesthetic zone, recognizing these anomalies will facilitate a successful treatment.

Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A placebo-controlled clinical study.

BACKGROUND: The purpose of this prospective, randomized, double-blind, placebo-controlled study was to compare the effect of the administration of preoperative ibuprofen, ketorolac, combination of etodolac with paracetamol and combination of aceclofenac with paracetamol versus placebo for the potential increased effectiveness of the inferior alveolar nerve block [IANB] anesthesia. MATERIALS AND METHODS: A total of 100 endodontic emergency patients in moderate to severe pain diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, either a drug or placebo 30 minutes before the administration of a conventional IANB. Cold testing was done before administration of anesthesia to determine level of pain using Heft-Parker Visual Analogue Scale (VAS) score. Success was defined as no pain or pain (VAS) on access or initial instrumentation. RESULTS: Overall success was 54% for all the groups. Success was highest (70%) for the ketorolac group, 55% for both ibuprofen group and combination of aceclofenac with paracetamol group, 50% for combination of etodolac with paracetamol group, and 40% for the placebo group. CONCLUSIONS: Under the conditions of this study, the use of preoperative medication did improve the anesthetic efficacy of IANB for the treatment of teeth diagnosed with irreversible pulpitis but not significantly.